Figure 4
Illustrations of the main signaling cascades stimulated by ACTH, from binding to its receptor to cellular function in adrenocortical
cells. (A) ACTH binds to MC2R and through interaction with MRAPs (Module 1) and initiates signaling, by activating Gs and
various isoforms of ACs that increase cAMP. MC2R is also linked to Gi protein; activation of αi decreases the level of cAMP, whereas the release of βγ-subunits stimulates other effectors such
as Mitogen-activated protein kinases (MAPK) cascade or cationic Cl− channels (Module 2). Binding of cAMP to the regulatory subunits of protein kinase A results in the phosphorylation of several
proteins, including steroidogenic acute regulatory protein (StAR) and the hormone-sensitive lipase. Protein kinase A (PKA)
also regulates the level of expression of the receptors implicated in the uptake of cholesterol and genes encoding the steroidogenic
enzymes (Module 5). The final output of this cascade is steroidogenesis, which is initiated in the mitochondria. cAMP also
has a number of PKA-independent effects, including involvement of the exchange protein directly activated by cAMP (Epac1/2).
cAMP also regulates its own intracellular level through activation of phosphodiesterases, in particular, PDE2 and PDE8 (Module
5). (B) Simultaneously, ACTH induces depolarization of the cell membrane inducing Ca2+ influx (Module 3). PKA also activates Ca2+ influx through L-type channels. The subsequent increase in intracellular calcium (Cai) activates Ca2+-CaMK and steroidogenesis (Module 6). (C) Activated MC2R also interact with ECM and cytoskeleton-associated proteins (Module
4), modulating the phosphorylation and activation of a number of proteins that are involved in functional integrity of the
cells. A decrease in paxillin phosphorylation and activation of the phosphotyrosine phosphatase, SHP2, itself activated by
PKA-dependent serine phosphorylation is responsible for the rapid effect of ACTH on the rounding-up of adrenocortical cells
in culture. SHP2 also induces dephosphorylation of specific substrate(s), including some involved directly or indirectly in
steroidogenesis, such as the acyl-CoA synthetase (ACS4), which sequesters AA as arachidonyl-CoA (AA-CoA) (Module 5), hence
participating in StAR activation and initiation of steroidogenesis (Module 6). Cytoskeleton-associated proteins and/or PKA
are also implicated in the activation of the MAPK signaling, necessary to promote the trophic action of ACTH (Module 5). Clearly
identified pathogenic mutations of key proteins are indicated in red. Among these mutations are loss of function of MC2R or MRAPs, activating mutations of the GNAS gene (encoding Gsα subunit), inactivating mutations of genes encoding the regulatory subunit of PKA (Ria) (PRKAR1A), encoding phosphodiesterases (PDE11A and PDE8B) or Aldo-keto- reductases (AKR1B1). Some mutations in voltage-dependent K+ channels are directly involved in primary aldosteronism, in particular mutations of the KCNJ5 gene encoding the potassium
channel Kir3.4 (also called G-protein-activated inward rectifier potassium channel 4, GIRK4), and of the two genes KCNQ1 and KCNE1, encoding the pore- and regulatory subunits of the slowly activating delayed K+ current, Iks. The resulting sustained Ca2+ influx increases activation of CYP11B2 and thus sustained increase in aldosterone secretion. Finally, the temporal integration
of these signaling pathways may be coordinated at the levels of signaling microdomains, for example, through A kinase-anchoring
proteins, or AKAPs (not illustrated).